<link rel="stylesheet" media="screen" type="text/css" href="<?php echo bu("css/datepicker.css"); ?>" />
<script type="text/javascript" src="<?php echo bu("js/datepicker.js"); ?>"></script>
<script>
		$(function() {
      $( ".dpicker" ).datepicker({
        changeMonth: true,
        changeYear: true,
        dateFormat: 'd MM yy',
      });
    });
</script>

<div class='mainContainer home'> <!-- Main div for the contain, behaves like a table-->
	<div><!-- Direct child of mainContainer, behaves like a table cell-->
		<?php // echo $this->renderPartial('/partials/_notifications'); ?>
		<h2 class='differentAlign'>CEC Registration Form</h2>
		<div class='spacer'>&nbsp;</div>
		<?php
      $form=$this->beginWidget('CActiveForm', array(
      'action' => bu('users/cec'),
      // 'enableClientValidation'=>true,
      'htmlOptions' => array(
        'name' => 'myForm',
        'class' => 'myForm customForm',
        'enctype' => 'multipart/form-data',
      )
      ));
    ?>
      <?php echo $form->errorSummary($model); ?><br />

      <fieldset>
        <legend>Chosen Program</legend>
        <table style="width:100%">
        <tr>
          <td style="width:200px;"><?php echo $form->labelEx($model,'academic_plan'); ?></td>
          <td class="radio">
            <?php
              $array = array(
                'FULL PROGRAM PCP' => 'FULL PROGRAM PCP',
                'FULL PROGRAM TCP' => 'FULL PROGRAM TCP',
                'BASIC' => 'BASIC',
              );
            ?>
            <?php echo $form->dropDownList($model, 'academic_plan', $array, array('separator' => ' ')); ?>
            <?php echo $form->error($model, 'academic_plan'); ?>
          </td>
        </tr>
        </table>
      </fieldset>

      <fieldset>
        <legend>Personal Information</legend>

        <table style="width:100%">
        <tr>
          <td style="width:200px;"><?php echo $form->labelEx($model,'uploadedFile'); ?></td>
          <td colspan=3>
            <?php echo $form->fileField($model,'uploadedFile'); ?>
            <?php echo $form->error($model,'uploadedFile'); ?>
          </td>
        </tr>
        <tr>
          <td style="width:200px;"><?php echo $form->labelEx($model,'full_name_degree'); ?></td>
          <td>
            <?php echo $form->textField($model, 'full_name_degree', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'full_name_degree'); ?>
          </td>

          <td><?php echo $form->labelEx($model,'nick_name'); ?></td>
          <td>
            <?php echo $form->textField($model, 'nick_name', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'nick_name'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'birth_city'); ?></td>
          <td>
            <?php echo $form->textField($model, 'birth_city', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'birth_city'); ?>
          </td>

          <td><?php echo $form->labelEx($model,'birth_date'); ?></td>
          <td>
            <?php echo $form->textField($model, 'birth_date', array('class' => 'full dpicker', 'required' => 'required', 'readonly' => 'true')); ?>
            <?php echo $form->error($model, 'birth_date'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'mailing_address'); ?></td>
          <td colspan=3>
            <?php echo $form->textField($model, 'mailing_address', array('class' => 'input_full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'mailing_address'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'city'); ?></td>
          <td>
            <?php echo $form->textField($model, 'city', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'city'); ?>
          </td>

          <td><?php echo $form->labelEx($model,'postal_code'); ?></td>
          <td>
            <?php echo $form->textField($model, 'postal_code', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'postal_code'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'telephone'); ?></td>
          <td>
            <?php echo $form->textField($model, 'telephone', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'telephone'); ?>
          </td>
          
          <td><?php echo $form->labelEx($model,'phone_cellular'); ?></td>
          <td>
            <?php echo $form->textField($model, 'phone_cellular', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'phone_cellular'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'email'); ?></td>
          <td colspan=3>
            <?php echo $form->textField($model, 'email', array('class' => 'input_full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'email'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'sex'); ?></td>
          <td class="radio" colspan=3>
            <?php
              $arr = array(
                'Male' => 'Male',
                'Female' => 'Female',
              );
            ?>
            <?php echo $form->radioButtonList($model, 'sex', $arr, array('separator' => ' ')); ?>
            <?php echo $form->error($model, 'sex'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'marital_status'); ?></td>
          <td class="radio" colspan=3>
            <?php
              $arr = array(
                'Married' => 'Married',
                'Single' => 'Single',
              );
            ?>
            <?php echo $form->radioButtonList($model, 'marital_status', $arr, array('separator' => ' ')); ?>
            <?php echo $form->error($model, 'marital_status'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'church'); ?></td>
          <td>
            <?php echo $form->textField($model, 'church', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'church'); ?>
          </td>

          <td><?php echo $form->labelEx($model,'active_serving'); ?></td>
          <td style='width:130px;'>
            <?php echo $form->textField($model, 'active_serving', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'active_serving'); ?>
          </td>
        </tr>
        </table>
      </fieldset>

      <fieldset>
        <legend>Occupation</legend>

        <table style="width:100%">
        <tr>
          <td style="width:200px;"><?php echo $form->labelEx($model,'institution_name'); ?></td>
          <td>
            <?php echo $form->textField($model, 'institution_name', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'institution_name'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'position'); ?></td>
          <td>
            <?php echo $form->textField($model, 'position', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'position'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'office_address'); ?></td>
          <td>
            <?php echo $form->textField($model, 'office_address', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'office_address'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'office_city'); ?></td>
          <td>
            <?php echo $form->textField($model, 'office_city', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'office_city'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'office_email'); ?></td>
          <td>
            <?php echo $form->textField($model, 'office_email', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'office_email'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'office_postal_code'); ?></td>
          <td>
            <?php echo $form->textField($model, 'office_postal_code', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'office_postal_code'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'office_telephone'); ?></td>
          <td>
            <?php echo $form->textField($model, 'office_telephone', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'office_telephone'); ?>
          </td>
        </tr>
        </table>
      </fieldset>

      <fieldset>
        <legend>Academic Activity</legend>

        <table style="width:100%">
        <tr>
          <td style="width:200px;"><?php echo $form->labelEx($model,'academic_name'); ?></td>
          <td colspan=3>
            <?php echo $form->textField($model, 'academic_name', array('style' => 'width:420px', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'academic_name'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'field_study'); ?></td>
          <td colspan=3>
            <?php echo $form->textField($model, 'field_study', array('style' => 'width:420px', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'field_study'); ?>
          </td>
        </tr>
        </table>
      </fieldset>
      
      <fieldset>
        <legend>Please confirm captcha correctly</legend>
        <?php $form->widget('CCaptcha'); ?><br />
        <?php echo $form->textField($model, 'verifyCode'); ?>
        <?php echo $form->error($model, "verifyCode"); ?>
      </fieldset>

      <p>* is required</p>
			<input type='submit' value='Submit' />
			<input type='submit' value='Reset' />
		<?php $this->endWidget(); ?>
	</div>

    <div class='rightPane'>
		<h2 class='differentAlign'>Our <span class='differentHeading'>Contact</span></h2>
		<div class="contact">
			<h3>ACSI Head Quarters</h3>
      731 Chapel Hills Drive Colorado Springs<br />
      CO 80920.3949<br />
      Phone : +1.719.528.6906<br />
      Fax : +1.719.531.0631<br />
      Email : info@acsiglobal.org
		</div>
    <div class="contact">
			<h3>ACSI Indonesia</h3>
      Komplek Ruko Klampis Megah B-25<br />
      Jl. Klampis Madya Utara I/6<br />
      Surabaya - Jawa Timur 60117<br />
      Phone/Fax : +62.31-591.0897, 591.3068<br />
      Phone : +62.31-592.9902<br />
      Mobile : +62.31-8193.5548<br />
      Email : acsi-indonesia@acsi.or.id<br />
      http://acsiglobal.org; acsi.or.id
		</div>
    <div class="contact">
			<h3>Indonesia Representative Office</h3>
      <b>Jakarta</b><br />
      Jl. Kwitang Raya No. 4, 3rd Floor<br />
      Senen - Jakarta Pusat 10420<br />
      Phone/Fax : +62.21-391.1207<br />
      Mobile : +62.31-3631-8020<br />
      Email : acsi-jakarta@acsi.or.id
		</div>
	</div>
</div>

<div class='spacer'>&nbsp;</div>